Traumatic Spinal Subdural Hematoma Research Articles

Traumatic spinal subdural hematoma: An illustrative case and series review

Traumatic spinal subdural hematomas (SDH) are a rarely reported pathology that can cause permanent neurologic deficit. Evidence is lacking to guide management decisions. We present an illustrative case of traumatic spinal SDH managed conservatively, and systematically review reports of traumatic spinal SDH for variables predictive of a favorable outcome. A systematic review was performed including demographic, clinical, and radiographic variables extracted from case studies. t-tests, Pearson's Chi-squared, and Fischer's Exact test were used to determine group differences in outcome. Fifty-eight reported cases, including our illustrative case, met inclusion criteria. The majority of patients were male (66.7%) with a mean age of 41.3 ± 24.7 years. Most traumas were minor (62.1%) with those presenting after a direct spinal trauma more likely to have a poor outcome. Common presenting symptoms included back pain (N = 45, 77.6%), radiculopathy (N = 33, 56.9%), and subjective weakness (N = 39, 67.2%). Neurologic deficit was present in 51.7% of patients, and in all those with a poor outcome (p < 0.001). Favorable outcome was reported in 47 patients (81.0%) and concomitant cranial SDH was statistically more common in this group (61.7%, p = 0.002). In trauma patients presenting with back pain, weakness, or neurologic deficits, spinal SDH should be considered in the differential. Reassurance and conservative management can often be first-line therapy, and presence of cranial SDH may suggest a favorable outcome. Neurologic deficit and cord compression on presentation are associated with poor outcome and warrant urgent surgical treatment.

Traumatic lumbar spinal subdural hematoma

Spinal subdural hematoma (SDH) is a rare and potentially life-threatening condition associated with trauma, lumbar puncture, hemorrhagic disorder, anticoagulant therapy, spinal surgery, tumor, vascular malformations, and spinal or epidural anesthesia. Traumatic SDH is even more uncommon than other forms of SDH with only 10 reported cases in the literature. Following a punch to the head and loss of consciousness, a 35-year-old man reported headaches, right-sided tinnitus, and dull ache behind both eyes. He also experienced sacral pain with stiffness that was exacerbated by movement. MRI showed an isolated lumbar SDH causing mild stenosis. On follow-up, the patient still experienced right-sided tinnitus and bilateral sacral radiculopathy and was prescribed prednisone with repeat MRI at 6weeks. At the next follow-up, the patient’s radiculopathy had resolved completely. Our case illustrates rapid resolution of a posttraumatic spinal SDH after treatment with oral corticosteroids. Recognition of blood products on MRI is vital to diagnosis and expedient treatment. There is agreement that prompt laminectomy with evacuation of SDH should be performed before permanent damage to the spinal cord occurs. Including our patient, 4 of 11 reported cases of thoracic or lumbar SDH resolved with conservative treatment.

Traumatic Lumbosacral Spinal Subdural Hematoma Mimicking Subdural Lipoma: Value of Computed Tomography

Traumatic Lumbosacral Spinal Subdural Hematoma Mimicking Subdural Lipoma: Value of Computed Tomography Sun-Chul Hwang, M.D.*, Hyung-Kan Kim, M.D.*, Seong-Hee Cho, M.D.*, Dae-Chul Nam, M.D.*, Heon-Keun Lee, M.D., Kyeong-Eon Park, M.D., Jae-Boem Na, M.D., and Dong-Hee Kim, M.D.* Departments of *Orthopaedic Surgery, Anesthesiology, and Radiology, Resarch Institute of Clinical Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea

Traumatic subdural hematoma in the lumbar spine

Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits.

A rare, high cervical traumatic spinal subdural hematoma

Spinal subdural hematomas (SSDH) are rare lesions occurring in association with a wide variety of conditions, including anticoagulation, coagulation disorders, spinal anesthesia, lumbar puncture, spinal tumors and vascular malformations. SSDH resulting from trauma are the exception. We present a 62-year-old woman with a rare post-traumatic focal SSDH at C1 with bulbomedullary compression, treated successfully with surgery. A review of the literature revealed 26 patients with traumatic SSDH. The aim of this report is to describe the clinical presentation, imaging characteristics and management of traumatic SSDH. The controversial pathogenesis is also discussed.

Angiographically Occult Vascular Malformation of the Cauda Equina Presenting Massive Spinal Subdural and Subarachnoid Hematoma

We report a case of a non traumatic spinal subdural hematoma or subarachnoid hematoma manifesting as lumbago, leg pain and bladder dysfunction that showed angiographically occult vascular malformation (AOVM). Although the spinal angiogram did not reveal any vascular abnormality, the follow-up magnetic resonance image showed AOVM. Complete surgical removal was performed due to the aggravated bladder dysfunction. This case highlights the need to consider bleeding due to spinal AOVM, even when angiography is negative.

Acute Cervical Spinal Subdural Hematoma Not Related to Head Injury

We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

Traumatic Subacute Spinal Subdural Hematoma Successfully Treated With Lumbar Drainage

A case report. To report a rare case of traumatic subacute spinal subdural hematoma (SDH) successfully treated by lumbar drainage. Few reports on traumatic spinal SDH are available in the English literature. The authors present a rare case of traumatic subacute spinal SDH. A 43-year-old man developed severe pain in his back and both legs approximately 3 weeks after a trivial car accident that occurred 1 month before presentation. The patient reported paresthesia in the L5 and S1 dermatomes bilaterally and a walking difficulty because of severe leg pain. He assessed his pain severity as 8 using the visual analog pain score scale. Magnetic resonance imaging of the lumbar spine revealed a spinal SDH extending from the level of the L5 vertebral body to S1-S2 disc space. The spinal SDH was drained by lumbar puncture at the L5-S1 level without surgical exploration. The intensity of the pain decreased considerable immediately, and he was able to walk independently. The patient recovered uneventfully and a follow-up magnetic resonance imaging conducted 4 weeks after the procedure revealed complete disappearance of the hematoma. Traumatic spinal SDH is extremely rare and is usually associated with intracranial injury. Here, the authors report a rare case of traumatic spinal SDH not associated with head injury, which was successfully treated by lumbar drainage.

Traumatic Subdural Hematoma of the Thoraco-Lumbar Junction of Spinal Cord

Spinal subdural hematoma (SSDH) is an exceedingly uncommon and potentially neurologically devastating condition. Recognition of blood products in magnetic resonance imaging is a very important clue for the diagnosis of SSDH. It is generally agreed that prompt surgical evacuation should be performed before irreversible damage to the spinal cord occurs. However, conservative treatment still plays a role in the management of SSDH. To describe the clinical presentation, characteristic MRI findings, and treatment of traumatic SSDH. A case of traumatic SSDH at the thoraco-lumbar junction. Magnetic resonance imaging findings of high signal intensity lesion in both T1 and T2 sequences suggest the possibility of subdural hematoma although it may be mistaken for tumorlike cystic lesion of the cord. Although there is a place for conservative treatment of subdural hematoma, we believe that rapid surgical drainage of the subdural hematoma will be associated with the best prognosis especially in the cervical, thoracic, and thoraco-lumbar junctions of the spinal cord. Rapid surgical drainage of traumatic SSDH affecting the thoraco-lumbar junction of the cord will be associated in most of the cases with rapid neurologic recovery.

MRI Findings of Traumatic Spinal Subdural Hematoma

Purpose: To describe the MR imaging findings of traumatic spinal subdural hematoma. Materials and Methods : We retrospectively reviewed the MR images of six patients , with symptoms of acute spinal cord or cauda equena compression after trauma, together with spinal subdural hematoma. We analysed the extent, location, configuration and signal intensity of the lesions. Results : In five of six cases, hematomas were distributed extensively throughout the thoracolumbosacral or lumbosacral spinal levels. In five cases they were located in the dorsal portion of the thecal sac, and in one case, in the ventral portion. On axial images, hematomas showed a concave or convex contour, depending on the amount of loculated hematoma. A lobulated appearance was due to limitation of free extension of the hematoma within the subdural space at the lateral sites (nerve root exist zone) at whole spine levels, and at the posteromedian site under lumbar 4-5 levels. Conclusion: In cases of spinal subdural hematoma, the lobulated appearance of hematoma loculation in the subdural space that bounds the lateral sites at all spinal levels and at the posteromedian site under L4-5 levels is a characteristic finding.

Traumatic Spinal Subdural Hematoma

A 15-year-old boy developed back pain and sciatica after a minor trauma. Magnetic resonance imaging revealed lumbar spinal subdural hematoma. After repeated lumbar spinal puncture and drainage of hemorrhagic fluid, spinal subdural hematoma was resolved completely. The benefits of conservative treatment by lumbar spinal puncture are discussed.